This invention relates to surgical devices, and in particular to a triceps or everting forceps for performing anastomosis that include skin closures and tissue closures.
As used herein, an anastomosis refers to a variety of procedures in which blood vessels, other tubular body parts, or body tissue are surgically joined or reconnected using clips, sutures, adhesives, etc. The joinder is not limited to tubular structures, and may include solid body parts such as skin, nerves or other body tissue. The tubular vessels and tissue may be joined end-to-end or end-to-side. For ease of reference, the discussion will primarily refer to joining tubular vessels.
Anastomosis typically involves mechanically joining vessels, typically using clips, sutures, etc. To do so, the edges of the vessel are first everted, or turned outward to form flanges that may be gripped by the clips or fastening mechanism. Eversion increases the ease and reliability of the mechanical joining, and places the interior surfaces of the vessels in contact. For non-penetrating joinder, as used in some surgical clips, it is preferred that the eversion be accurate and symmetric with the edges of the tissue aligned to facilitate fastening. But symmetric eversion is difficult to achieve and maintain while applying the clips. Thus, there is a need for an improved tool to align the edges of the vessels and other body parts for joining by anastomosis.
Furthermore, while performing anastomosis, the surgeon must often use one side a triceps tool to grip and position one vessel or piece of tissue, and use the other side of the triceps to grip and position the other vessel or piece of tissue to be joined. It can be difficult to hold two vessels or pieces of tissue with one instrument. In addition, to achieve the proper grip the surgeon must squeeze the triceps with the correct amount of pressure. If squeezed too tightly the triceps may damage the tissue either by pinching crushing, or more often because the triceps tips slide over each other and create a scissoring action that can cut the tissue. If squeezed too loosely, the tissue is difficult to position or even falls out of the triceps. The requirement of a precise triceps holding pressure is complicated by the need to hold two vessels or pieces of tissue simultaneously. There is thus a need for a way to adequately grip the body parts without damaging them, and to manipulate those parts into position for anastomosis.
Moreover, it is advantageous that the same surgeon both positions the body parts for anastomosis and performs the joinder of the vessels/tissues, by placing surgical clips or otherwise. Thus, it is advantageous that the surgeon handle the triceps with one hand while performing the joinder with the other. Accordingly, there is a need for a hand operable tool that permits the same surgeon to both hold the body parts for anastomosis and apply the surgical clips or other means for joining the body parts.
The triceps of this invention allows compression of two outer legs toward each other and toward a middle leg so a surgeon can engage tissue for anastomosis between the distal ends of the middle leg and one or both of the outer legs. By removably latching at least one of the outer legs relative to the middle leg, and latching in a position to hold the engaged tissue without damage, the surgeon can better manipulate the triceps. The latch mechanism essentially relieves the surgeon of applying the correct pressure and avoids accidentally disengaging the tissue from the latched portion of the triceps. Advantageously, the latching is achieved by moving at least one of the middle and the outer legs toward each other to latch, with further movement toward each other disengaging the latch mechanism. A Castro Viejho latching mechanism is preferred.
A further advantage is offered by interposing a stop intermediate the middle leg and one or both of the outer legs to limit the motion of the distal ends of the outer legs and to prevent gripping the body tissue too tightly. However, the grip on the engaged tissue can also be loosened, or even tightened, despite the stop. For example, if the stop engages a first outer leg, then by pressing on that first outer leg between the stop and the distal end the grip on the body tissue can be tightened. But pressing on that outer leg between the joined ends and the stop will cause the outer leg to pivot about the stop and open the distal ends, thus loosening the grip on the tissue and allowing adjustments. By placing a finger on each opposing side of the stop, the surgeon can pivot the outer leg and its distal end to open or close one side of the triceps. This allows fine adjustments in the gripping force to facilitate manipulation of gripped tissue.
A similar advantage arises by interposing a stop intermediate the latch mechanism and the distal end of the outer leg. The middle and outer legs can be moved toward each other until either the stop or the latch limits the motion. Advantageously, the relative motion is stopped at a point where the distal end of the middle and outer leg grip the tissue firmly enough to position it for anastomosis without damaging the tissue. The latching mechanism is then engaged to hold the engaged tissue. But the grip on that engaged tissue can be adjusted by pressing between the latch mechanism and the stop, which causes the outer leg to pivot about the stop and loosen the grip on the engaged tissue. By placing a finger on each opposing side of the stop, the surgeon can pivot the outer leg and its distal end to open or close one side of the triceps. There is provided a means of holding the tissue with a triceps while adjusting the grip on the body tissue to facilitate repositioning and manipulating the triceps or tissue.
Additionally, the distal end of the middle leg preferably has a convexly curved surface, and is preferably circular or elliptical with the major axis of the ellipse intersecting the distal ends of the outer legs of the triceps. The distal ends of the adjoining outer legs have concavely curved surfaces that are advantageously, but not necessarily, of a different radius of curvature than the convex surface. When the concave distal ends of the outer legs urge tissue against the convex surface of the middle leg, the tissue everts. The different shapes of the distal ends of the legs help the eversion, with the curvature being gradual enough to avoid cutting or damaging the engaged tissue. There is thus provided an advantageous shape of the distal ends to evert the tissue for anastomosis. Further, by urging the everted tissue against the flange, the aligned tissue is more easily joined.
There is provided a surgical triceps having three legs fastened at one end, and including two outer legs on opposing sides of a middle leg, the outer legs being configured to be separated from the middle leg and resiliently urgable toward the middle leg by finger pressure. Each leg has a free distal end that is separated from the adjacent distal ends but which may be resiliently urged together by finger pressure. The distal ends are configured for anastomosis so that in use, first and second pieces of tissue can be urged by the distal ends of the outer legs against the distal end of the middle leg with sufficient force to hold the tissue for joining. Preferably a Castro Viejho latch is placed on at least one of the legs engaging a portion of an adjacent leg to hold the adjacent legs in position. The latch is configured to achieve a predetermined spacing at the distal ends of the adjacent legs such that the distal end of the one outer leg and the distal end of the middle leg are spaced apart a distance sufficient to hold tissue for anastomosis.
Further, an alignment member advantageously extends from one of the middle or one of the outer legs and is aligned to engage a recess in the other of the middle or the other of the outer legs to ensure alignment of the distal ends of the middle leg and an adjacent distal end on one of the legs when the member engages the recess. Moreover, a stop preferably extends from one of the legs and is oriented so that the stop is interposed between two adjacent legs to contact and limit motion between said adjacent legs upon contact. Preferably, the stop and alignment member are coaxially located on a common member.
A feature is also provided for symmetric eversion. The distal end of the middle leg can have a flange extending outwardly from it, the flange being spaced from the distal end and toward the fastened ends a distance sufficient to contact the tissue being gripped by adjacent legs to align the tissue for symmetric eversion during use of the triceps. The flange extends from the middle leg a distance adequate to block passage of tissue to be joined by anastomosis during use of the triceps.
As described briefly above, and in more detail below, there is thus provided a latching means for holding at least two of the legs in a predetermined position relative to each other to hold body tissue in the distal ends of at least two legs. Further, the triceps can have alignment means for aligning the middle leg and at least one of the outer legs as the distal end of the aligned outer leg urges body tissue toward the distal end of the middle leg when in use. Moreover, the triceps can have means for limiting motion of the middle leg relative to one of the outer legs. Finally, the triceps can have means on the distal ends of the legs for everting tubular vessels, and aligning them for symmetric eversion.
The present invention also includes a new method for anastomosis using finger operated triceps having three legs fastened at one end and having distal ends configured for anastomosis. The method includes the step of manually moving the first leg toward the middle leg and engaging tissue for anastomosis between the distal ends of the middle leg and the first leg. The first outer leg and middle leg are removably latched in a position to hold the engaged tissue. As needed, the method engages a stop interposed between the first and middle legs to limit the relative motion between the distal ends of the first and middle legs. In further variations, the method also includes manually moving the second leg toward the middle leg and engaging tissue for anastomosis between the distal ends of the middle leg and the second leg. Additionally, the surgeon can urge an end of the tissue engaged between the first and middle legs and between the second and middle legs against an outwardly extending flange on the middle leg to align the ends of the tissue with the flange for symmetric eversion. As desired, the surgeon can also engage a stop interposed between the second and middle legs to limit the relative motion between the distal ends of the second and middle legs to prevent tissue damage from the triceps. Moreover, by interposing the stop intermediate the middle and first outer legs and between the latch and the distal end of the first outer leg, the surgeon can move the middle and first outer legs toward each other until the stop limits the motion of the middle and first outer legs, and yet still be able to open the distance between the distal ends of the middle and first outer legs by pressing on the first outer leg intermediate the stop and the latch.